Page 21 - WJOLS - Journal of Laparoscopic Surgery

WJOLS

MSR Pradeep, V Sandeep Kumar 10.5005/jp-journals-10033-1316
REVIEW ARTICLE

Port-site Metastasis after Minimally Invasive Surgery for

Urological Malignancy: A Review of Literature

2
1 MSR Pradeep, V Sandeep Kumar

ABSTRACT malignant ovarian cystic adenoma in penetration sites of
Introduction: Port-site metastasis (PSM) has been a concern the pneumo-needle and trocar. Some specific procedures
with the common use of minimally invasive surgery, especially and tumors have been associated with a higher incidence
laparoscopy in urologic oncology. We conducted this study to of PSM or tumor seeding; however, the precise incidence
provide a review of PSMs reported after minimally invasive of PSM and its etiology and pathogenesis have not been
surgery in managing urologic malignancies, possible contribut- 8
ing factors and preventive measures. well defined in urologic laparoscopy.
Since the first successful laparoscopic nephrectomy in
Materials and methods: An electronic search of MEDLINE, 1
PubMed, Google Scholar, and HighWire Press with the 1991, minimally invasive approaches have been increas-
combined keywords “port-site metastasis” and “urology” was ingly used in tumor resection and lymph node dissection
carried out. for urologic cancers. This approach has multiple advan-
Results: A total of 40 articles comprising almost 60 cases tages, including decreased length of hospitalization,
2
addressing PSM after minimally invasive surgery for urological decreased pain, faster recovery, and improved cosmesis.
malignancy were identified. Laparoscopic surgery has equivalent oncologic outcomes
Conclusion: Port-site metastasis in urological laparoscopic to open procedures; however, PSM is rare, troubling, and
surgery is rare and is preventable. Risk can be minimized by often an unexplained occurrence. The first known occur-
applying open surgery oncological procedural principles.
rence of PSM after a urologic procedure was in 1994, when
Keywords: Laparoscopy, Port-site metastasis, Robotic, Uro- Stolla et al reported a case of subcutaneous metastasis of
9
logical malignancy.
bladder transitional cell carcinoma (TCC) after laparoscopic
How to cite this article: Pradeep MSR, Kumar VS. Port- pelvic lymph node dissection. Since then, about 50 PSMs
site Metastasis after Minimally Invasive Surgery for Uro- 10
logical Malignancy: A Review of Literature. World J Lap Surg have been reported in the setting of urologic surgery.
2017;10(3):102-107. Port-site metastasis is a multifactorial phenomenon
Source of support: Nil with an as-yet undetermined incidence. Etiological factors
include natural malignant disease behavior, host immune
Conflict of interest: None
status, local wound factors, laparoscopy-related factors,
INTRODUCTION such as aerosolization of tumor cells (the use of gas, type
of gas, insufflation and desufflation, and pneumoperito-
In recent years, questions have been raised about the neum) and sufficient technical experience of the surgeons
1
oncologic safety of laparoscopic and robotic approach. and operating team (adequate laparoscopic equipment,
Even though a large number of specialized centers around skill, minimal handling of the tumor), surgical manipula-
2,3
the world perform laparoscopy for urologic cancer, local tion, wound contamination during instrument change,
recurrence and PSM still remain a concern. 4 organ morcellation, and specimen removal. 9
When PSMs occur, they often do so in the presence
of advanced disease, but it is not uncommon for them to MATERIALS AND METHODS
occur in isolation. 5,6 An electronic search of MEDLINE, PubMed, Google
The first known report of a PSM was by Dobronte
7
et al in 1978. The authors reported implantation of Scholar, and HighWire Press of the published literature
up to 2017 was carried out using the combined key words
“port-site metastasis” and “Urology.”
1 Consultant, Senior Resident Duplicate references, as well as repeated references to
2
1 Department of Urology, Kakatiya Medical College, Warangal the same data sets, were removed. The articles and case
Telangana, India reports directly addressing PSM after minimally invasive
2 Department of Urology, Osmania Medical College, Hyderabad surgery for urological malignancy were reviewed.
Telangana, India
RESULTS
Corresponding Author: MSR Pradeep, Consultant, Department
of Urology, Kakatiya Medical College, Warangal, Telangana Table 1 11-16 shows the case reports found on MEDLINE,
India, e-mail: raghavendrapradeep@yahoo.com
PubMed, Google Scholar, and HighWire Press; search of
102